Thyroseq^®V2.0 Molecular testing: A cost-effective approach for the evaluation of indeterminate thyroid nodules

Objective: Approximately 15 to 30% of thyroid nodules have indeterminate cytology. Many of these nodules are treated surgically, but only 5 to 30% are malignant. Molecular testing can further narrow the risk of malignancy of these nodules. Our objective was to assess the cost effectiveness of ThyroSeq^®V2.0 compared to diagnostic thyroidectomy for the evaluation of indeterminate nodules. Methods: Cytology and histopathology slides of Bethesda category III and IV (suspicious for follicular neoplasia [SFN]) nodules obtained between January 1, 2014 and November 30, 2016 were re-reviewed by 2 endocrine cytopathologists. Costs for a diagnostic approach using ThyroSeq^® were calculated and compared to those of diagnostic thyroidectomy. Results: We included 8 Bethesda category III nodules that underwent ThyroSeq^® and 8 that underwent diagnostic surgery. Of those submitted for ThyroSeq^®, 4 were positive for mutations and underwent thyroid surgery. The average cost per nodule evaluated was $14,669 using ThyroSeq^®, compared to $23,338 for diagnostic thyroid surgery. The cost per thyroid cancer case detected was $58,674 using ThyroSeq^® compared to $62,233 for diagnostic thyroid surgery. We included 13 nodules Bethesda category IV that underwent ThyroSeq^® and 11 that underwent diagnostic surgery. Of those submitted for ThyroSeq^®, 6 were positive for mutation and underwent thyroid surgery. The average costs per nodule evaluated were $14,641 using ThyroSeq^® and $24,345 using diagnostic thyroidectomy. The cost per thyroid cancer case detected was $31,721 when using ThyroSeq^® compared to $53,560 for diagnostic thyroidectomy. Conclusion: The use of ThyroSeq^® in our institution is cost effective compared to diagnostic thyroid surgery for the evaluation of Bethesda categories III and IV (SFN) nodules. (Endocr Pract. 2018;24:780-788)